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Cagle JG, Zhang P, Clem S. Estimating the Impact of Hospice Care on Key Patient-Family Care Outcomes Using a Nationwide U.S. Probability Sample. Am J Hosp Palliat Care 2024; 41:978-986. [PMID: 37989148 DOI: 10.1177/10499091231218261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023] Open
Abstract
Hospice is touted as an exemplary model for end-of-life care. However, there is little generalizable evidence estimating benefits of hospice at the national level. Using a national population-based probability sample of U.S. adults with weights applied (data collected Spring/Summer 2015), we conducted six logistic regression models to evaluate linkages between hospice involvement and end-of-life outcomes (pain, home death, presence of family, access to life-prolonging care, respect for spiritual/religious beliefs, financial burden) from N = 235 informal caregivers of decedents prior to death. Respondents were M = 55 years old (SD = 17), 55% female, 77% White, 91% non-Hispanic, and 71% had cared for a hospice recipient. In fully adjusted analyses, hospice users had better reported outcomes observed in two models: (a.) presence of family/friends at death (OR = 2.82, SE = .48, P < .05), and (b.) respect for spiritual/religious beliefs (OR = 9.52, SE = .73, P < .01). Hospice utilization was not statistically significant (P > .05) in all other adjusted models. Although more research is needed, findings support claims that hospice remains a high quality option for end-of-life care in the U.S.
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Affiliation(s)
- John G Cagle
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Peiyuan Zhang
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - Sarah Clem
- University of Maryland School of Social Work, Baltimore, MD, USA
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Becker TD, Clem SE, Sacco P, Cagle JG, Davitt JK, Kusmaul N. Further Psychometric Evaluation of the Eight-Item Hospice Philosophy Scale: Results From a National Sample of Interdisciplinary Hospice Clinicians. J Appl Gerontol 2024:7334648241265183. [PMID: 39030730 DOI: 10.1177/07334648241265183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
This study examined the psychometric properties of the eight-item Hospice Philosophy Scale (HPS-8) through confirmatory factor analysis; differential item functioning by age, gender, race, and professional discipline; and internal consistency reliability. We administered the HPS-8 to a national convenience sample of 471 interdisciplinary hospice clinicians. Confirmatory factor analysis results supported a one-factor model with an error correlation between two similarly worded items, χ2(19) = 48.38, p < .001 (RMSEA = .06, SRMR = .03, CFI = .98, TLI = .97). "Multiple indicators, multiple causes" model results indicated differential item functioning by age, race, and/or professional discipline on five items. However, subsequent uncorrected and differential item functioning-corrected models detected no statistically significant HPS-8 mean differences by grouping variables. Composite reliability results (CR = .82) demonstrated acceptable internal consistency reliability. Our results support the HPS-8 as a valid and reliable measure of attitudes toward the hospice philosophy of care in hospice clinicians.
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Affiliation(s)
- Todd D Becker
- Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Sarah E Clem
- University of Maryland School of Social Work, Baltimore, MA, USA
| | - Paul Sacco
- University of Maryland School of Social Work, Baltimore, MA, USA
| | - John G Cagle
- University of Maryland School of Social Work, Baltimore, MA, USA
| | - Joan K Davitt
- University of Maryland School of Social Work, Baltimore, MA, USA
| | - Nancy Kusmaul
- University of Maryland School of Social Work, Baltimore, MA, USA
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Van Dussen DJ, Coyne SR, Ward RE. Veteran's Attitudes and Knowledge of End-of-Life Care: A Pilot Study Using a Mixed Methods Approach. Am J Hosp Palliat Care 2024; 41:747-753. [PMID: 37751735 DOI: 10.1177/10499091231204990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2023] Open
Abstract
Veterans make up a quarter of the deaths in the United States (US). However, little is known about their knowledge and preferences about end-of-life care and pain management. Given this, we were interested in how veterans' military experiences impact their end-of-life experiences and attitudes. Our exploratory study addressed the knowledge and perceptions of hospice and pain management at the end of life. The quantitative aspect was a survey using descriptive statistics that used a small (n = 14) subgroup from a randomly selected sample in the continental US. A small population-based sample (N = 123) used a blended sampling frame of randomly selected validated cell phone and landline numbers. The qualitative aspect examined eight targeted interviews of urban dwelling older veterans over age 60 residing in Northeast Ohio to get a deeper understanding of their knowledge and attitudes toward end-of-life care. Our findings suggest that veterans did not understand the difference between hospice and palliative care and expressed concerns regarding pain medication use at the end of life. Future research examining the concept of stoicism at the end of life among veterans and educational interventions are needed.
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Cagle JG, Carrion I, Becker TD, Zhang P. Spanish Translation and Dissemination of EMPOWER Materials to Address Barriers to Pain Management at the End of Life. Palliat Med Rep 2024; 5:162-170. [PMID: 38665226 PMCID: PMC11043617 DOI: 10.1089/pmr.2023.0090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 04/28/2024] Open
Abstract
Introduction The Effective Management of Pain by Overcoming Worries to Enable Relief (EMPOWER) intervention is an evidence-supported approach for addressing barriers to pain management (e.g., patient/family concerns about addiction) at the end of life. Such barriers appear more pronounced among Spanish-speaking individuals. This study aimed to (1) translate EMPOWER materials into Spanish, (2) disseminate materials to hospices with ≥25% Hispanic patients, and (3) survey hospices about the use and usefulness of materials. Methods We back translated EMPOWER materials with harmonization, then disseminated materials to 242 hospices. Thereafter, we used a semistructured survey to assess use and usefulness of EMPOWER materials using univariate statistics and content analysis. Results Thirty-eight hospice representatives responded (participation rate = 15.7%). Respondents were primarily non-White (55.3%) and Hispanic (60.5%). Nealy half (47.4%) were nurses. A majority (81.6%) indicated they currently employ ≥1 full-time English-Spanish bilingual team member. Among those who reported receiving the EMPOWER materials (n = 29), 58.6% indicated they-or another staff member-used them with patients or families. Using a single-item rating (0 = not useful to 10 = very useful), respondents evaluated the English EMPOWER materials' usefulness as 7.6 (standard deviation [SD] = 1.4) and Spanish materials as 8.4 (SD = 1.4). Most (62.1%) indicated they would likely use EMPOWER materials in the future. Conclusion Thematic findings suggest EMPOWER reinforces clinical education, promotes discussion about pain management, and helps address culturally specific barriers to care. EMPOWER appears to be a useful, easy to use, and promising intervention that can be implemented among both English- and Spanish-speaking populations.
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Affiliation(s)
- John G. Cagle
- University of Maryland School of Social Work, Baltimore, Maryland, USA
| | - Iraida Carrion
- University of South Florida School of Social Work, Tampa, Florida, USA
| | - Todd D. Becker
- University of Maryland School of Social Work, Baltimore, Maryland, USA
| | - Peiyuan Zhang
- University of Maryland School of Social Work, Baltimore, Maryland, USA
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Khosla N. "It Seems Like a Bad Thing": US South Asian Youths' Perspectives About the Use of Hospice Care. Am J Hosp Palliat Care 2024; 41:383-390. [PMID: 37265240 DOI: 10.1177/10499091231180819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND South Asians are one of the fastest growing populations in the US. Family based decision making is common among this population. Little is known about their knowledge and attitudes towards hospice use. OBJECTIVE This study explored US South Asian youths' knowledge of, and attitudes towards hospice care. DESIGN Qualitative study, using focus group discussions. METHODS Thirty-six university students of South Asian heritage participated in ten focus group discussions. Data were coded inductively and deductively. Thematic analysis was performed. Disagreements were resolved through discussion. RESULTS Participants were in consensus that if patients had an incurable, fatal condition, keeping them comfortable was important. Several participants were unaware of the terms 'hospice' and 'palliative care'. After these terms were explained, most opposed hospice care for reasons of 'desire for a normal life', 'cultural incompatibility', 'concerns about the hospice environment' and 'preference for home as the place of death'. Some were opposed to even home hospice fearing that it would continuously remind the family and patient about impending death. Concerns were also expressed about having a 'stranger' in the home to provide hospice care. One participant said she would support hospice use if it aligned with the patient's values. Others cited financial reasons and quality of life as considerations in choosing hospice care. CONCLUSIONS Research is needed on culturally-appropriate modes of palliative care education and advocacy for South Asian populations in the US, especially youth, that are often the decision makers for the care of older family members.
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Affiliation(s)
- Nidhi Khosla
- Department of Public Health, California State University East Bay, Hayward, CA, USA
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Liu X, Berkman C. Hospice Knowledge, Attitudes, and Preference among Older Chinese Immigrants in the United States. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2024; 20:201-216. [PMID: 38557360 DOI: 10.1080/15524256.2024.2330920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Racial disparities in hospice use are a longstanding concern in the U.S. Asian Americans are among the least likely to receive hospice care and to be included in studies on this topic. This study examined the knowledge, attitudes, and preferences related to hospice care among older Chinese immigrants and associated factors. A sample of 262 Chinese immigrants age 60+ was recruited from six older adult centers in NYC. In-person interviews were conducted in Mandarin and Cantonese. Non-English-speaking older Chinese immigrants had very limited knowledge about hospice care. Only 26% of respondents had heard of hospice, and a few could correctly define any components. After receiving a comprehensive definition of hospice care, study participants expressed a positive attitude and a strong willingness to use hospice if near the end of life. Notably, some respondents still held misconceptions about hospice and were less positive in their attitude and preference for hospice care. These findings underscore the necessity for clear and accessible information about hospice among this population throughout the trajectory from good health to end of life. Further research is needed to identify the range of factors that influence the attitudes and preferences of older Chinese immigrants toward hospice care.
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Affiliation(s)
- Xiaofang Liu
- Columbia Population Research Center, Columbia University, New York, New York, USA
| | - Cathy Berkman
- Graduate School of Social Service, Fordham University, New York, New York, USA
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Tate CE, Mami G, McNulty M, Rinehart DJ, Yasui R, Rondinelli N, Treem J, Fairclough D, Matlock DD. Evaluation of a Novel Hospice-Specific Patient Decision Aid. Am J Hosp Palliat Care 2024; 41:414-423. [PMID: 37477279 PMCID: PMC11083913 DOI: 10.1177/10499091231190776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background: We tested a novel hospice-specific patient decision aid to determine whether the decision aid could improve hospice knowledge, opinions of hospice, and decision self-efficacy in making decisions about hospice. Methods: Two patient-level randomized studies were conducted using two different cohorts. Recruitment was completed from March 2019 through May 2020. Cohort #1 was recruited from an academic hospital and a safety-net hospital and Cohort #2 was recruited from community members. Participants were randomized to review a hospice-specific patient decision aid. The primary outcomes were change in hospice knowledge, hospice beliefs and attitudes, and decision self-efficacy Wilcoxon signed rank tests were used to evaluate differences on the primary outcomes between baseline and 1-month. Participants: Participants were at least 65 years of age. A total of 266 participants enrolled (131 in Cohort #1 and 135 in Cohort #2). Participants were randomized to the intervention group (n = 156) or control group (n = 109). The sample was 74% (n = 197) female, 58% (n = 156) African American and mean age was 74.9. Results: Improvements in hospice knowledge between baseline and 1-month were observed in both the intervention and the control groups with no differences between groups (.43 vs .275 points, P = .823). There were no observed differences between groups on Hospice Beliefs and Attitudes scale (3.29 vs 3.08, P = .076). In contrast, Decision Self-Efficacy improved in both groups and the effect of the intervention was significant (8.04 vs 2.90, P = -.027). Conclusions: The intervention demonstrated significant improvements in decision self-efficacy but not in hospice knowledge or hospice beliefs and attitudes.
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Affiliation(s)
- Channing E. Tate
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Aurora, CO, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gwendolyn Mami
- President and CEO, Global Collaborations, LLC, Denver, CO, USA
- Advisory Team Chair, Zion Senior Center, Denver, CO, USA
| | - Monica McNulty
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Aurora, CO, USA
| | - Deborah J. Rinehart
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Center for Health Systems Research, Office of Research, Denver Health and Hospital Authority, Denver, CO, USA
| | - Robin Yasui
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicole Rondinelli
- Division of Palliative Care, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jonathan Treem
- Division of Palliative Care, University of Colorado School of Medicine, Aurora, CO, USA
| | - Diane Fairclough
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Aurora, CO, USA
| | - Daniel D. Matlock
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, CO, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, CO, USA
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Starr LT, Washington K, Pitzer K, Oliver DP, Demiris G. Close but Not Close Enough: How Distance Caregiving is Associated with Hospice Family Caregiver Hospice Communication Experiences. HEALTH COMMUNICATION 2024; 39:482-492. [PMID: 36683376 PMCID: PMC10362092 DOI: 10.1080/10410236.2023.2170199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Half of hospice family caregivers report having unmet information needs, which can contribute to poor pain and symptom management, emergency department use, and hospice disenrollment for care-recipients and to caregiver strain and stress. Effective communication between hospice teams and family caregivers is critical yet communication inadequacies persist. Despite the growing prevalence of distance caregiving, including in hospice care, and the relationship between caregiver proximity and communication effectiveness, little is known about how caregiver proximity is associated with caregiver perceptions of hospice communication. In this secondary analysis of quantitative data from two multisite randomized clinical trials (NCT03712410 and NCT02929108) for hospice family caregivers (N = 525), multivariate linear models with demographic and contextual controls were used to analyze caregivers' perceptions of caregiver-centered communication with hospice providers based on caregiver proximity to the hospice care-recipient. In multivariate models, "local" hospice family caregivers who lived within 1 hour of the hospice care-recipient reported less effective communication with the hospice team than co-residing caregivers; and older caregivers rated communication more favorably than younger caregivers. To improve communication and collaboration between hospice teams and caregivers, regardless of proximity, distance communication training for hospice teams and interventions such as telehealth communication and virtual tools that enable triadic collaboration are recommended. Research is needed to understand why local caregivers, specifically, perceive communication quality less favorably and how hospice teams can better meet local and distance caregiver communication needs.
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Affiliation(s)
- Lauren T. Starr
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, Pennsylvania
| | - Karla Washington
- Washington University in St. Louis School of Medicine, Division of Palliative Medicine, St. Louis, Missouri
| | - Kyle Pitzer
- Washington University in St. Louis School of Medicine, Division of Palliative Medicine, St. Louis, Missouri
| | - Debra Parker Oliver
- Washington University in St. Louis School of Medicine, Division of Palliative Medicine, St. Louis, Missouri
- Barnes Jewish College, Goldfarb School of Nursing, St. Louis, Missouri
| | - George Demiris
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Department of Biobehavioral Health Sciences, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine, Department of Biostatistics and Epidemiology, Philadelphia, Pennsylvania
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Balasubramanian I, Malhotra C. Why is end-of-life inpatient cost high among cancer patients? A prospective cohort study. Cancer Med 2024; 13:e7057. [PMID: 38457240 PMCID: PMC10923043 DOI: 10.1002/cam4.7057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 01/23/2024] [Accepted: 02/16/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Inpatient cost for cancer patients is high during the last year of life, but reasons for this are not understood. We aim to understand the type of hospital admissions and inpatient services associated with an increase in inpatient cost in last year of life. METHODS We used survey and billing records of 439 deceased patients with a solid metastatic cancer, enrolled in a prospective cohort study. Based on cost per day of inpatient admissions, we classified admissions as low- or high-intensity. We decomposed the inpatient cost into cost for different inpatient services. We examined the inpatient cost in the last year of life. We also assessed patient characteristics associated with higher inpatient cost in the next 3 months. RESULTS Towards death, proportion of inpatient cost for "maintenance care" increased while that for intensive care unit (ICU) and surgeries decreased. Low-intensity, compared to high-intensity admissions had a higher proportion of cost for "maintenance care" and a lower proportion for surgeries and ICU. Number of low-intensity admissions increased more steeply towards death than high-intensity admissions. Both admission types contributed equally to the share of inpatient cost. Older patients were less likely to have a high-intensity admission (β:-0.01, CI: -0.02, 0.00). Greater preference for life extension (β: 0.06, CI: 0.01, 0.11) and inaccurate prognostic belief were associated with higher cost of high-intensity admissions (β: 0.32, CI: 0.03, 0.62). CONCLUSIONS Findings suggest that inpatient costs in last year of life may be reduced if maintenance care is availed in low-cost settings such as hospice/palliative care alongside steps to reduce non-beneficial surgeries and ICU admissions.
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Affiliation(s)
| | - Chetna Malhotra
- Lien Centre for Palliative Care, Duke‐NUS Medical SchoolSingaporeSingapore
- Program in Health Services and Systems Research, Duke‐NUS Medical SchoolSingaporeSingapore
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Corr CA. Some Reflections on the 50th Anniversary of Hospice Care in America. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231218217. [PMID: 38039094 DOI: 10.1177/00302228231218217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
This article celebrates the 50th anniversary of hospice care in America. It also offers a brief recounting of one person's reflections on some aspects of the history, achievements, and current status of American hospice care.
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Affiliation(s)
- Charles A Corr
- School of Humanities, Southern Illinois University at Edwardsville, Edwardsville, IL, USA
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Bakhsh AS, Faraj RI, Alashqar M, Alsahafi I. Caregiver Knowledge About Palliative Care in King Abdullah Medical City, Makkah, Saudi Arabia: A Cross-Sectional Study (2023). Cureus 2023; 15:e50258. [PMID: 38196427 PMCID: PMC10774841 DOI: 10.7759/cureus.50258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2023] [Indexed: 01/11/2024] Open
Abstract
Background Understanding palliative care (PC) can hinder access to it. To address this, further research into the factors influencing knowledge and awareness of PC is required to develop effective public health campaigns. This study aimed to estimate the knowledge and awareness of PC among primary family caregivers of patients present to the palliative department at King Abdullah Medical City, Makkah, Kingdom of Saudi Arabia (KSA), in 2023, and to determine the factors affecting the family caregiver's awareness about PC. Materials and methods This cross-sectional study was conducted in 2023 among patients' family caregivers in the palliative department of King Abdullah Medical City, Makkah, KSA. The patient was evaluated by palliative service as an inpatient or outpatient presentation. A score, namely "caregivers' general knowledge of palliative care," was used as a study variable. Each of the questions was converted to points and calculated using a simple additive method. The total score was converted to a categorical variable. To discard the null hypothesis, a conventional p-value <0.05 was used. Results The 378 family primary caregivers completed the self-administered questionnaire. The majority (73.8%) were unaware of PC until their family member was admitted to the hospital. The mean score of caregivers' general knowledge is 2.75+0.9, indicating that they have limited knowledge about PC. Age, employment status, relation to the patient, and duration of receiving PC are significantly associated with their knowledge. No associations were found on gender, level of education, and tumor site. Participants aged 26-35 years old (p<0.001), those who are students (p=0.002), who are brother/sister of the patient (p<0.001), and less than one year of PC (p<0.001) significantly related to caregivers' knowledge. Conclusion A low knowledge mean score was found in this study. This indicated that participants had limited knowledge of PC. This study suggested that effective PC education programs and increasing specialized facilities be developed to raise the awareness of both caregivers and patients.
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Affiliation(s)
- Alaa S Bakhsh
- Palliative Care, King Abdullah Medical City, Makkah, SAU
| | - Rami I Faraj
- Palliative Care, King Abdullah Medical City, Makkah, SAU
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Mushi GL, Serventi F, Alloyce JP, Saria VF, Xu X, Khan K, Cheng Q, Chen Y. Willingness of advanced cancer patients to receive palliative care and its determinants: A cross-sectional study in Northern Tanzania. PLoS One 2023; 18:e0290377. [PMID: 37796779 PMCID: PMC10553290 DOI: 10.1371/journal.pone.0290377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 08/07/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The purpose of this study was to assess willingness of advanced cancer patients to receive palliative care and its determinants at Cancer Care Centre in Kilimanjaro Christian Medical Centre Northern Tanzania. OBJECTIVE The purpose of this study was to assess willingness of advanced cancer patients to receive palliative care and its determinants at Cancer Care Centre in Kilimanjaro Christian Medical Centre Northern Tanzania. METHODS This was an institution-based cross-sectional study and the target population was all advanced cancer patients attending care at Cancer care Centre in Northern Tanzania. Data was collected using a structured questionnaire and analysed using Stata for windows 15. A descriptive analysis was conducted to summarize the data using mean standard deviation, while categorical data was summarized using frequency and percentages. Both bivariate and multivariate logistic regression analysis was used to determine the predictors associated with willingness to receive palliative care. RESULTS The results showed that more than half of the respondents had willingness to accept palliative care. The degree of willingness PC among advanced cancer patients was high 60.6% (95%CI: 55.8-65.3). The predictors which remained significant associated with willingness to receive palliative care in multivariate analysis were the knowledgeable of palliative care [AOR: 2.86; 95%CI: 1.69-4.85] and high perceived benefits of palliative care [AOR: 3.58; 95%CI: 2.12-6.04]. CONCLUSION Willingness to accept palliative care services was more than half of the patients just 60.6% among patients with advanced cancer from the study site. Advanced age of a patient, occupations, better knowledge, and perceived benefits for palliative care was the significant predictor for patients' willingness to accept palliative care.
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Affiliation(s)
- Grace Leonard Mushi
- Xiangya School of Nursing, Central South University, Changsha City, Hunan Province, People’s Republic of China
- Department of Nursing, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Furaha Serventi
- Department of Oncology, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Julius Pius Alloyce
- Department of Oncology, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Vivian Frank Saria
- Department of Nursing, Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Xianghua Xu
- Xiangya School of Nursing, Central South University, Changsha City, Hunan Province, People’s Republic of China
| | - Khalid Khan
- Xiangya School of Nursing, Central South University, Changsha City, Hunan Province, People’s Republic of China
| | - Qinqin Cheng
- Xiangya School of Nursing, Central South University, Changsha City, Hunan Province, People’s Republic of China
| | - Yongyi Chen
- Xiangya School of Nursing, Central South University, Changsha City, Hunan Province, People’s Republic of China
- Nursing Department, Hunan Cancer Hospital and The Affiliated Cancer Hospital of Xiangya School of Medicine, Changsha, Hunan Province, China
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Wallace CL, Coccia K, Khoo YM, Bullock K. Meaning of Hospice Care: Perceptions of Patients and Families. Am J Hosp Palliat Care 2023; 40:1132-1140. [PMID: 36594567 DOI: 10.1177/10499091221149702] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: About half of hospice-eligible adults die without hospice each year. Misconceptions about hospice are frequently identified as barriers to utilization, but hospice perceptions are not well documented. Objectives and Setting/Subjects: To examine perceptions of hospice (initial and post-enrollment) among 90 U.S. patients/families actively enrolled in a large, metropolitan hospice in Texas, and to identify factors associated with participant perceptions. Design and Measurement: Concurrent mixed methods and cross-sectional design collecting data via research questionnaire with Likert scales and open-ended questions. Wilcoxon signed-rank test determined differences between recall of initial hospice perceptions at time of referral and perceptions while actively receiving services; Fisher's exact and Kruskal-Wallis tests were used to examine bivariate relationships between perceptions of hospice and satisfaction with physician communication and demographic variables. Qualitative statements were analyzed using an inductive, content analysis approach. Results: There was a significant difference between participants' perceptions of hospice recalled from initial conversations compared with current perceptions following hospice enrollment (z = -6.44, P < .01). Initial perceptions of hospice were significantly related to satisfaction with physician communication (P = .011) and diagnosis (P = .019). Qualitative themes range from negative (ie hospice = death) to positive (ie comfort, support, loving staff) with 65.6% of participants demonstrating positive increases in understanding. Conclusion: Participants' perceptions of hospice were positively associated with satisfaction with physician communication prior to hospice enrollment, and potentially impacted by the experience of care itself. During hospice discussions, clinicians should elicit patient and family perceptions in addition to providing descriptions of eligibility and services.
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Affiliation(s)
- Cara L Wallace
- School of Social Work, Saint Louis University, Saint Louis, MO, USA
| | - Kathryn Coccia
- School of Social Work, Saint Louis University, Saint Louis, MO, USA
| | - Yit Mui Khoo
- School of Social Work, Saint Louis University, Saint Louis, MO, USA
| | - Karen Bullock
- Boston College School of Social Work, Chestnut Hill, MA, USA
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Yeo SL, Ng RHL, Peh TY, Lwin MO, Chong PH, Neo PSH, Zhou JX, Lee A. Public sentiments and the influence of information-seeking preferences on knowledge, attitudes, death conversation, and receptiveness toward palliative care: results from a nationwide survey in Singapore. Palliat Care Soc Pract 2023; 17:26323524231196311. [PMID: 37719387 PMCID: PMC10504834 DOI: 10.1177/26323524231196311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 08/03/2023] [Indexed: 09/19/2023] Open
Abstract
Background Low awareness about palliative care among the global public and healthcare communities has been frequently cited as a persistent barrier to palliative care acceptance. Given that knowledge shapes attitudes and encourages receptiveness, it is critical to examine factors that influence the motivation to increase knowledge. Health information-seeking from individuals and media has been identified as a key factor, as the process of accessing and interpreting information to enhance knowledge has been shown to positively impact health behaviours. Objective Our study aimed to uncover public sentiments toward palliative care in Singapore. A conceptual framework was additionally developed to investigate the relationship between information-seeking preferences and knowledge, attitudes, receptiveness of palliative care, and comfort in death discussion. Design and Methods A nationwide survey was conducted in Singapore with 1226 respondents aged 21 years and above. The data were analysed through a series of hierarchical multiple regression to examine the hypothesised role of information-seeking sources as predictors. Results Our findings revealed that 53% of our participants were aware of palliative care and about 48% were receptive to receiving the care for themselves. It further showed that while information-seeking from individuals and media increases knowledge, attitudes and receptiveness to palliative care, the comfort level in death conversations was found to be positively associated only with individuals, especially healthcare professionals. Conclusion Our findings highlight the need for public health authorities to recognize people's deep-seated beliefs and superstitions surrounding the concept of mortality. As Asians view death as a taboo topic that is to be avoided at all costs, it is necessary to adopt multipronged communication programs to address those fears. It is only when the larger communicative environment is driven by the media to encourage public discourse, and concurrently supported by timely interventions to trigger crucial conversations on end-of-life issues between individuals, their loved ones, and the healthcare team, can we advance awareness and benefits of palliative care among the public in Singapore.
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Affiliation(s)
- Su Lin Yeo
- Associate Professor, Lee Kong Chian School of Business, Singapore Management University, 50 Stamford Road, 178899, Singapore
| | - Raymond Han Lip Ng
- Senior Consultant, Palliative and Supportive Care, Woodlands Health Singapore
| | - Tan-Ying Peh
- Senior Consultant, Division of Supportive & Palliative Care, National Cancer Centre Singapore & Clinical Director at Assisi Hospice, Singapore
| | - May O. Lwin
- Professor, Wee Kim Wee School of Communication & Information, Nanyang Technological University Singapore, Singapore
| | - Poh-Heng Chong
- Medical Director, HCA Hospice Care & Vice Chair, Singapore Hospice Council, Singapore
| | - Patricia Soek Hui Neo
- Senior Consultant & Head, Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Jamie Xuelian Zhou
- Consultant, Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Angel Lee
- Medical Director, St Andrew’s Community Hospital, Singapore
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15
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Liu J, Li JF, Li XX, Wu YP, Li SR, Li LY, Zhou HP. Awareness of Hospice Care Among Community-Dwelling Elderly Participants. Res Theory Nurs Pract 2023; 37:386-400. [PMID: 37591529 DOI: 10.1891/rtnp-2023-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
Background and Purpose: The main goal of hospice care is to improve the quality of life for people who are at the end-of-life phase. However, investigations on the awareness of hospice care among community-dwelling elderly participants are limited. This work aimed to reveal the awareness status of hospice care and explore the factors influencing the awareness rate among elderly participants. Methods: A questionnaire survey was conducted among individuals aged 60 years and above. Results: A total of 4,969 individuals aged 60 years and above were randomly selected from 48 primary medical institutions in Handan. The awareness rate of hospice care in the baseline survey was 19.3% (n = 959). All included individuals were divided into two groups in accordance with their awareness of hospice care. The awareness of hospice care among participants with low educational level, living alone, and afraid of talking about death was low (p < .05). Implications for Practice: The level of awareness of hospice care among community-dwelling elderly participants is low. The influencing factors included educational level, living status, and fear of talking about death. The community-dwelling elderly participants' awareness of hospice care must be improved. It is recommended that public medical education and training should be enhanced to improve knowledge and awareness of hospice care among community-dwelling elderly residents with low educational level, living alone, and afraid of talking about death.
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Affiliation(s)
- Jun Liu
- Department of Geriatrics, Handan Central Hospital, Handan, China
| | - Jun-Fang Li
- Department of Geriatrics, Handan Central Hospital, Handan, China
| | - Xiao-Xiao Li
- Department of Geriatrics, Handan Central Hospital, Handan, China
| | - Yi-Ping Wu
- Department of Neurology, Handan Central Hospital, Handan, China
| | - Shu-Rui Li
- Department of Geriatrics, Handan Central Hospital, Handan, China
| | - Li-Yang Li
- Department of Geriatrics, Handan Central Hospital, Handan, China
| | - Hai-Ping Zhou
- Department of Ageing and Health, Medical Association of Handan, Handan, China
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16
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Becker TD, Cagle JG. Bereavement Support Services in a National Sample of Hospices: A Content Analysis. OMEGA-JOURNAL OF DEATH AND DYING 2023; 86:1235-1253. [PMID: 33823699 DOI: 10.1177/0030222821997602] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although the Medicare Hospice Benefit mandates that hospices offer bereavement support services to families for at least 1 year following the death of a patient, it does not stipulate which services they should offer. As a result, little is known about what bereavement support services hospices provide, especially on a national scale. The current study recruited a national sample of hospice representatives who responded to an open-ended question that asked, "What types of bereavement support services does your hospice provide to families?" Seventy-six viable responses were recorded and content analyzed. Four overarching domains emerged: (a) timing of support, (b) providers of support, (c) targets of support, and (d) formats of support. Other notable findings included the underutilization of bereavement support services and the utility of informal support formats. These findings present implications for future study regarding which specific aspects of hospice bereavement support services are most beneficial to bereaved families.
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Affiliation(s)
- Todd D Becker
- 115980University of Maryland School of Social Work, Baltimore, MD, United States
| | - John G Cagle
- 115980University of Maryland School of Social Work, Baltimore, MD, United States
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17
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Becker TD, Cagle JG. Priority Research Topics and Patient and Family Needs in a National Sample of Hospice Agencies. J Pain Symptom Manage 2023; 65:133-142. [PMID: 36328176 DOI: 10.1016/j.jpainsymman.2022.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 10/17/2022] [Accepted: 10/19/2022] [Indexed: 11/06/2022]
Abstract
CONTEXT Various contextual factors surrounding hospice care have reinforced the need for scholars to pursue practice-relevant research questions. Although priority-setting is a primary approach to streamline such efforts, research appears yet to have conducted priority-setting with hospice professionals. OBJECTIVE To describe the areas of needed research and clinical focus voiced by a national probability sample of US hospice agency representatives. METHODS A national probability sample of 600 hospice agencies proportionately stratified by state and profit status was surveyed. At the end of the survey, participants indicated whether or not they were willing to answer two additional open-ended questions. These two questions requested participants' input on areas of needed attention related to (1) research topics and (2) unmet needs for patients and families. Responses were content analyzed. RESULTS A total of 317 surveys were completed (response rate = 61.8%). Viable responses were recorded by 129 participants responding to at least one item. Content analysis generated the following five categories (and various subcategories): earlier access to hospice, education (outside physicians, patients and families, public), policy barriers to hospice enrollment (hospice eligibility and reimbursement, gaps in insurance coverage), effects of policy restrictions on hospice care (reimbursement for care, pain management, clinician issues), and improving the provision of in-home hospice care (community resources, supports for caregivers, supports for when caregiver assistance is inadequate, needs already are being met). CONCLUSION These findings presented by hospice agency representatives reflect directions for research and clinical development. Efforts are needed to cohere professional- and patient-reported areas of needed attention.
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Affiliation(s)
- Todd D Becker
- University of Maryland School of Social Work, Baltimore, Maryland, USA.
| | - John G Cagle
- University of Maryland School of Social Work, Baltimore, Maryland, USA
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18
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Yao N, Chen H, Lai X. Hospice preference of the family decision-makers for cancer patients in China: an exploratory study. Palliat Care 2022; 21:222. [PMID: 36517835 PMCID: PMC9753404 DOI: 10.1186/s12904-022-01112-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The reasons for hospice underuse in China need exploration from the perspective of patients with cancer and their families. Furthermore, existing literature about hospice decision-making among Chinese families with cancer patients is limited. This study aimed to investigate the awareness of hospice care among families with cancer patients, their preference for healthcare at the end-of-life stage of care, and the predictors of hospice preference. METHODS This was an exploratory study conducted between July 2021 and January 2022. Overall, 300 decision-makers of cancer patients were recruited from the oncology ward of seven hospitals in Shanghai, China. Of these, 285 valid responses were included in the data analysis. A self-developed questionnaire about their preference for healthcare when the patient was at the end-of-life stage was completed. Descriptive analysis, t-test, chi-square test, and multivariable logistic regression were conducted to analyze the data. RESULTS Only 46.0% of the participants have heard of hospice care. Most participants (78.2%) reported no introduction to hospice care from their doctors. More than half of the participants (58.2%) did not have a preference for healthcare at the end-of-life stage. Seventy-eight (65.5%) of the 119 participants who had a preference chose hospice care, and the other 41 participants (34.5%) refused hospice care. Having heard of hospice care had a significant impact on preferring healthcare at the end-of-life stage (adjusted OR = 14.346, 95%CI 7.219-28.509, p < 0.001). Not being sure whether the doctor introduced hospice care before had a significant impact on having no preference for healthcare at the end-of-life stage (adjusted OR = 0.180, 95%CI 0.052-0.617, p = 0.006). Another family member being cared for at home had a significant impact on the participants' hospice preference (adjusted OR = 2.739, 95%CI 1.159-6.470, p = 0.022). CONCLUSION The end-of-life communication between healthcare providers and the families of cancer patients is insufficient. More efforts should be made in increasing the awareness of hospice care among patients with cancer and their families. Further study is needed to explore the reasons for a lack of discussion on hospice options between healthcare providers and the patients' families. Additionally, the impact of the at-home care burden on the hospice choice of families with cancer patients requires further study.
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Affiliation(s)
- Nian Yao
- grid.8547.e0000 0001 0125 2443School of Nursing, Fudan University, Shanghai, China
| | - Hao Chen
- grid.8547.e0000 0001 0125 2443School of Nursing, Fudan University, Shanghai, China
| | - Xiaobin Lai
- grid.8547.e0000 0001 0125 2443School of Nursing, Fudan University, Shanghai, China
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19
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Brereton E, Harger G, Matlock DD, Dorsey Holliman B, Tate CE. How Do Patients Describe Hospice Care? A Qualitative Analysis of the Language Used by Older Adults to Describe Hospice Care. J Palliat Med 2022; 25:1692-1696. [PMID: 35944273 PMCID: PMC9836666 DOI: 10.1089/jpm.2022.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 01/22/2023] Open
Abstract
Background: Misconceptions about hospice are prevalent and create barriers to hospice enrollment. These misconceptions may be a result of the confusing language around hospice care. Objective: To conduct a content analysis exploring the language used and accuracy in which older adults describe hospice. Design: Participants in two prior studies were asked to describe hospice in their own words. Responses were coded inductively to explore the language used, and deductively to evaluate accuracy in describing hospice. Subjects: Two hundred sixty-six adults, aged at least 65 years or older. Results: The most common language used to describe hospice care related to "comfort," "care," and "family." Most participants accurately describe hospice eligibility, services, and goals of care but inaccurately described location of hospices services. Conclusions: Participants accurately described most of the logistical aspects of hospice care and words such as comfort, care, and family are commonly used to describe services suggesting preferred language for communication interventions. Clinicaltrials.gov (Cohort #1 NCT03794700 and Cohort #2 NCT04458090).
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Affiliation(s)
- Elinor Brereton
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Geoffrey Harger
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Daniel D. Matlock
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
| | - Brooke Dorsey Holliman
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Channing E. Tate
- Adult and Child Center for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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20
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Lee HY, Noh H, Choi E, Lee LH. Social determinants of willingness to discuss end-of-life care with family and doctors among Korean American immigrants: Findings from a cross-sectional survey in Alabama. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6056-e6066. [PMID: 36164279 DOI: 10.1111/hsc.14043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 08/22/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
Prior research reported lower engagement in end-of-life discussions and planning among Korean American (KA) immigrants; however, there is a dearth of research investigating factors associated with their willingness to discuss their end-of-life care wishes. This study aimed to examine the willingness to have end-of-life discussions with family and doctors among KA immigrants and social determinants of health (SDH) associated with willingness. A self-administered, cross-sectional survey was conducted with a convenience sample of 259 KA immigrants recruited from two counties in Alabama. Demographic, health, acculturation and SDH information were collected. Logistic regression analyses were conducted to examine associations between SDH and willingness for end-of-life discussion with family and doctors, respectively. The majority of the sample was willing to discuss end-of-life care with family (94%) and doctors (82%). Those with hospice awareness were more likely to have willingness for discussion with family (OR = 27.70, p < 0.001) and doctors (OR = 5.01, p < 0.001). Those who could not see a doctor because of cost (OR = 0.03, p < 0.01) and who had higher threats to interpersonal safety (OR = 0.74, p < 0.05) were less likely to have willingness for discussion with family. Those who had more chronic conditions (OR = 0.60, p < 0.05) and higher levels of social isolation (OR = 0.77, p < 0.05) were less likely to have willingness for discussion with doctors. The SDH identified in this study should be considered in developing interventions to promote end-of-life discussions in the KA immigrant community. Future research should investigate the associations explored in this study in a larger and more representative sample.
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Affiliation(s)
- Hee Y Lee
- Research/Endowed Academic Chair on Social Work and Health, School of Social Work, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Hyunjin Noh
- School of Social Work, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Eunyoung Choi
- School of Global Public Health, New York University, New York, New York City, USA
| | - Lewis H Lee
- School of Social Work, The University of Alabama, Tuscaloosa, Alabama, USA
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21
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Lin H, Ko E, Wu B, Ni P. Hospice Care Preferences and Its Associated Factors among Community-Dwelling Residents in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159197. [PMID: 35954548 PMCID: PMC9368034 DOI: 10.3390/ijerph19159197] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023]
Abstract
Hospice care is a comprehensive approach addressing patients’ physical, psychosocial, and spiritual needs at the end of life (EoL). Despite the recognition of its effectiveness in improving the quality of EoL care, little is known about hospice care in mainland China. In this study, we aimed to examine the preferences for hospice care and its related factors among community-dwelling residents in mainland China. Participants were recruited using a convenience sampling method, and 992 community-dwelling residents responded to an online survey from June 2018 to August 2019. The majority (66.7%) of the participants were female, and the mean age was 48.4 years. Approximately 28% of the participants had heard of hospice care, and 91.2% preferred to receive hospice care if diagnosed with a terminal illness. Participants who had heard of hospice care, and with higher levels of education (bachelor’s degree or above) and health insurance coverage were more likely to accept hospice care than their counterparts. Community-based education on hospice care is imperative to improve public knowledge and the acceptance of hospice care. Meanwhile, there is a need to develop policies to integrate and expand hospice care into clinical settings.
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Affiliation(s)
- Huijing Lin
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
| | - Eunjeong Ko
- School of Social Work, San Diego State University, San Diego, CA 92182, USA;
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York, NY 10010, USA;
- NYU Aging Incubator, New York University, New York, NY 10010, USA
| | - Ping Ni
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China;
- Correspondence: ; Tel.: +86-1387-1540-316
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22
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Cardenas V, Fennell G, Enguidanos S. Hispanics and Hospice: A Systematic Literature Review. Am J Hosp Palliat Care 2022; 40:552-573. [PMID: 35848308 PMCID: PMC9845431 DOI: 10.1177/10499091221116068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background. Hospice has been shown to improve patient and family satisfaction with care, reduce hospitalizations and hospital costs, and reduce pain and symptoms. Despite more than 40 years of hospice care and related research in the U.S., few studies examining hospice experiences have included Hispanics. Thus, little is known about hospice barriers, facilitators, and outcomes among Hispanics.Aim. This systematic literature review aimed to provide a comprehensive overview of studies assessing knowledge of and attitudes toward hospice, barriers and facilitators to hospice use, utilization patterns, and hospice-related outcomes among Hispanics.Design. Between March 2019 and March 2020 we searched Ovid Medline (PubMed), EMBASE, and CINAHL, using search terms for hospice care, end-of-life care, Hispanics, and Latinos. All steps were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. U.S. studies that examined Hispanics' knowledge and attitudes towards hospice, facilitators or barriers to hospice use, hospice use, and hospice-related outcomes were included. Qualitative studies and non-empirical work were excluded. Study quality was assessed using Hawker's quality criteria.Results. Of the 4,841 abstracts reviewed, 41 peer-reviewed articles met the inclusion criteria. These studies largely report lower hospice knowledge and awareness among Hispanics and mixed results around hospice use and outcomes in comparison to Whites.Conclusion. There has been relatively little research focused specifically on Hispanics' experience with hospice. Future research should focus on testing interventions for overcoming hospice-related disparities among Hispanics and on improving access to quality hospice care among terminally ill Hispanics.
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Affiliation(s)
- Valeria Cardenas
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Gillian Fennell
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Susan Enguidanos
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
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23
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Noh H, Lee HY, Luo Y, Lee LH. Willingness to Discuss End-of-Life Care Wishes Among Rural Black/African American Residents of the Alabama Black Belt. J Appl Gerontol 2022; 41:1763-1772. [PMID: 35506710 DOI: 10.1177/07334648221084174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Willingness for end-of-life discussion and related factors among rural Blacks/African Americans of the Alabama Black Belt have not been well-studied. This study aims to assess their willingness for the discussion and examine its relationship with social determinants of health (SDH) and demographic factors. A cross-sectional survey was conducted with a convenience sampling of 182 participants. Most participants were willing to discuss end-of-life wishes with family (77.1%) or doctors (72.1%). Controlling for demographics, results from binary logistic regressions showed those with hospice awareness were more likely to have willingness for discussion with family (OR = 10.07, p < .01) and doctors (OR = 7.23, p < .05). Those who were older (50+) were less likely to have willingness for discussion with doctors (OR = 0.19, p < .05), whereas those who were more socially isolated were less likely to have willingness for discussion with family (OR = 0.53, p < .05). Therefore, end-of-life discussion efforts should focus on older, socially isolated individuals and consider hospice awareness.
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Affiliation(s)
- Hyunjin Noh
- The University of Alabama School of Social Work, Tuscaloosa, AL, USA
| | - Hee Y Lee
- The University of Alabama School of Social Work, Tuscaloosa, AL, USA
| | - Yan Luo
- The University of Alabama School of Social Work, Tuscaloosa, AL, USA
| | - Lewis H Lee
- The University of Alabama School of Social Work, Tuscaloosa, AL, USA
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24
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Lu X, Liu J. Factors Influencing Public Awareness of and Attitudes Toward Palliative Care: A Cross-Sectional Analysis of the 2018 HINTS Data. Front Public Health 2022; 10:816023. [PMID: 35462828 PMCID: PMC9021382 DOI: 10.3389/fpubh.2022.816023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background The global burden of serious health-related suffering requiring palliative care has been projected to grow significantly by 2060, which indicates the imminent need for integrating palliative care into health systems globally. Moreover, research evidence has been accumulating in support of the earlier adoption of palliative care into the treatment course of serious life-threatening illnesses. However, barriers to earlier access to palliative care still remain, which might be attributable to the global lack of awareness of palliative care and the prevalence of negative perceptions and attitudes. To address this, further investigation of the influencing factors of public perceptions of palliative care is imperative to help inform and develop effective targeted public health campaigns and education messages aimed at improving views of palliative care and thereby early access. Methods We used data from the Health Information National Trends Survey (HINTS), a nationally representative cross-sectional survey routinely administrated by the National Cancer Institute from the United States. Specifically, we analyzed the latest palliative care data from HINTS 5 Cycle 2 data set. Sociodemographic characteristics, individual factors such as self-perceived health status, and interpersonal factors such as relationship quality were examined as predictors of public awareness of and attitudes toward palliative care. Survey data were analyzed using SPSS 26 with multiple hierarchical regression tests. Results Results showed that people's quality of interpersonal relationships was a significant influencing factor of their awareness of and attitudes toward palliative care. Moreover, cancer diagnosis history and perceived healthcare quality were found to jointly affect their awareness of palliative care; perceived health status and patient centeredness interacted to influence their awareness of and attitudes toward palliative care. Finally, female, non-white, and poorer people were more aware of palliative care, while female and more educated people had more favorable attitudes. Conclusions The quality of social relationships emerges as a significant predictor of people's awareness of and attitude toward palliative care, as treatment options and decisions of serious life-threatening illnesses often involve the patients' family. The results hold strong implications for public health campaigns and education messages aiming at changing people's views of palliative care, which ultimately improve end-of-life outcomes.
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Affiliation(s)
- Xinyu Lu
- School of Journalism and Communication, Shanghai International Studies University, Shanghai, China
| | - Jiawei Liu
- School of Journalism and Communication, Jinan University, Guangzhou, China
- *Correspondence: Jiawei Liu
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25
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Enguidanos S, Storms AD, Lomeli S, van Zyl C. Improving Palliative Care Knowledge among Hospitalized Hispanic Patients: A Pilot Study. J Palliat Med 2022; 25:1179-1185. [PMID: 35119300 DOI: 10.1089/jpm.2021.0559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Lack of knowledge of palliative care has been identified as a primary barrier to access to care, with a recent survey reporting that Hispanics have the lowest rate of palliative care knowledge compared with other racial/ethnic groups. The purpose of this pilot study was to determine if there were trends toward improved palliative care knowledge after viewing four-minute video of a palliative care patient. Methods: We conducted a pre- and posttest pilot study among 50 Spanish-speaking, hospitalized Hispanic patients 40 years old and older in a large public hospital. We used the Palliative Care Knowledge Scale (PaCKS) to assess palliative care knowledge. Two questions measured intention to enroll in palliative care. Paired sample t-tests were conducted to investigate change in PaCKS scores. McNemar's test was used to compare differences in intentions to enroll in palliative care from pretest to posttest. We conducted linear regression analysis to determine factors associated with improved knowledge at posttest. Results: PaCKS scores revealed significant improvement in palliative care knowledge following viewing of the video, with scores increasing from an average of 6.4-11.4 at posttest. Intentions to enroll a family member in palliative care increased from 64% at pretest to 64%-98% at posttest. Intentions to enroll oneself increased from 72% to 92%. Conclusions: Brief exposure to a relatable role model may be effective in improving knowledge and intentions to enroll in palliative care services. More research is needed to determine if these videos are effective in increasing enrollment in palliative care.
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Affiliation(s)
- Susan Enguidanos
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Aaron D Storms
- Division of Geriatric, Hospital, Palliative, and General Internal Medicine, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Sindy Lomeli
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Carin van Zyl
- Division of Geriatric, Hospital, Palliative, and General Internal Medicine, Keck School of Medicine of USC, Los Angeles, California, USA
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26
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Cross SH, Ramkalawan JR, Ring JF, Boucher NA. “That little bit of time”: Transition-to-Hospice Perspectives from Hospice Staff and Bereaved Family. Innov Aging 2022; 6:igab057. [PMID: 35155835 PMCID: PMC8827325 DOI: 10.1093/geroni/igab057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Many patients lack understanding of hospice services and their preparation for the transition to hospice at home may be insufficient. This study explored how hospice admissions staff and caregivers of hospice patients perceive the hospice admission process and the transition to hospice at home. Research Design and Methods We conducted in-depth, semistructured interviews with 2 subgroups: hospice admissions staff (n = 15) and bereaved caregivers of former hospice patients (n = 20). We performed a 3-coder descriptive content analysis. Results There were 4 overall themes: (a) issues relating to the referring/prehospice provider, (b) issues relating to hospital discharge/care transition home, (c) issues relating to the first touch of hospice, and (d) the impact of coronavirus disease 2019 (COVID-19) on hospice admissions. Patients are often referred to hospice without clear prognostic understanding, at times placing staff in the uncomfortable position of breaking difficult news. Stigma may make patients and families fearful of enrolling in hospice, and misconceptions about hospice are common. Caregivers emphasize the need for increased attention to their emotional needs. Staff revealed the emotional challenges they experience conducting admissions. Both staff and caregivers indicate that the transition to hospice is often emotionally and logistically burdensome, especially when discharging home from the hospital. Both subgroups report insufficient caregiver preparation for taking care of a dying patient at home, particularly regarding medication management. COVID-19 created challenges yet prompted innovative changes to hospice admission processes. Discussion and Implications Findings demonstrate a need to improve the hospice admissions process, better supporting terminally ill patients and their families.
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Affiliation(s)
- Sarah H Cross
- Sanford School of Public Policy, Duke University, Durham, NC, USA
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
| | - Janel R Ramkalawan
- Sanford School of Public Policy, Duke University, Durham, NC, USA
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Nathan A Boucher
- Sanford School of Public Policy, Duke University, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health System HSR&D, Durham, NC, USA
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Noh H, Lee HY, Lee LH, Luo Y. Awareness of Hospice Care Among Rural African-Americans: Findings From Social Determinants of Health Framework. Am J Hosp Palliat Care 2021; 39:822-830. [PMID: 34856830 DOI: 10.1177/10499091211057847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Despite the need for hospice care as our society ages, adults in the U.S.'s southern rural region have limited awareness of hospice care. Objective: This study aims to assess the rate of awareness of hospice care among rural residents living in Alabama's Black Belt region and examine social determinants of health (SDH) associated with the awareness. Methods: A cross-sectional survey was conducted among a convenience sample living in Alabama's Black Belt region (N = 179, age = 18-91). Participants' awareness of hospice care, demographic characteristics (ie, age and gender), and SDH (ie, financial resources strain, food insecurity, education and health literacy, social isolation, and interpersonal safety) were assessed. Lastly, a binary logistic regression was used to examine the association between SDH and hospice awareness among participants while controlling for demographic characteristics. Results: The majority of participants had heard of hospice care (n = 150, 82.1%), and older participants (50 years old or older) were more likely to report having heard of hospice care (OR = 7.35, P < 0.05). Participants reporting worries about stable housing (OR = 0.05, P < 0.05) and higher social isolation were less likely to have heard of hospice care (OR = 0.53, P < 0.05), while participants with higher health literacy had a higher likelihood to have heard of it (OR = 2.60, P < 0.01). Conclusions: Our study is the first study assessing the status of hospice awareness among residents of Alabama's Black Belt region. This study highlighted that factors including age and certain SDH (ie, housing status, health literacy, and social isolation) might be considered in the intervention to improve hospice awareness.
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Affiliation(s)
- Hyunjin Noh
- The University of Alabama School of Social Work, Tuscaloosa, AL, USA
| | - Hee Y Lee
- The University of Alabama School of Social Work, Tuscaloosa, AL, USA
| | - Lewis H Lee
- The University of Alabama School of Social Work, Tuscaloosa, AL, USA
| | - Yan Luo
- The University of Alabama School of Social Work, Tuscaloosa, AL, USA
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Ingle MP, Valdovinos C, Ford KL, Zhou S, Bull S, Gornail S, Zhang X, Moore S, Portz J. Patient Portals to Support Palliative and End-of-Life Care: Scoping Review. J Med Internet Res 2021; 23:e28797. [PMID: 34528888 PMCID: PMC8485198 DOI: 10.2196/28797] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/02/2021] [Accepted: 07/27/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Although patient portals are widely used for health promotion, little is known about the use of palliative care and end-of-life (PCEOL) portal tools available for patients and caregivers. OBJECTIVE This study aims to identify and assess the user perspectives of PCEOL portal tools available to patients and caregivers described and evaluated in the literature. METHODS We performed a scoping review of the academic literature directed by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) extension for Scoping Review and searched three databases. Sources were included if they reported the development or testing of a feature, resource, tool, or intervention; focused on at least one PCEOL domain defined by the National Coalition for Hospice and Palliative Care; targeted adults with serious illness or caregivers; and were offered via a patient portal tethered to an electronic medical record. We independently screened the titles and abstracts (n=796) for eligibility. Full-text (84/796, 10.6%) sources were reviewed. We abstracted descriptions of the portal tool name, content, targeted population, and reported user acceptability for each tool from included sources (n=19). RESULTS In total, 19 articles describing 12 tools were included, addressing the following PCEOL domains: ethical or legal (n=5), physical (n=5), and psychological or psychiatric (n=2). No tools for bereavement or hospice care were identified. Studies have reported high acceptability of tools among users; however, few sources commented on usability among older adults. CONCLUSIONS PCEOL patient portal tools are understudied. As medical care increasingly moves toward virtual platforms, future research should investigate the usability and acceptability of PCEOL patient portal resources and evaluate their impact on health outcomes.
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Affiliation(s)
- M Pilar Ingle
- Graduate School of Social Work, University of Denver, Denver, CO, United States
| | - Cristina Valdovinos
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CO, United States
| | - Kelsey L Ford
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Shou Zhou
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Sheana Bull
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Starlynne Gornail
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Xuhong Zhang
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Susan Moore
- Colorado School of Public Health, University of Colorado, Aurora, CO, United States
| | - Jennifer Portz
- Department of General Internal Medicine, University of Colorado, Aurora, CO, United States
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Biswas J, Banik PC, Ahmad N. Physicians' knowledge about palliative care in Bangladesh: A cross-sectional study using digital social media platforms. PLoS One 2021; 16:e0256927. [PMID: 34469497 PMCID: PMC8409647 DOI: 10.1371/journal.pone.0256927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 08/18/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction Palliative care is still a new concept in many developing countries like Bangladesh. Basic knowledge about palliative care is needed for all physicians to identify and provide this care. This study aims to assess the preliminary knowledge level and the misconceptions about this field among physicians. Methods This cross-sectional study was conducted among 479 physicians using a self-administered structured questionnaire adapted from Palliative Care Knowledge Scale (PaCKs) on various digital social media platforms from December 2019 to February 2020. Chi-square, Fisher’s extract test, and the Monte Carlo extract test was done to compare the knowledge level with the study subjects’ demographic variables. Results An almost equal number of physicians of both genders from four major specialties and their allied branches took part in the study (response rate 23.9%). The majority (71%) of the respondents had an average to an excellent level of knowledge about palliative care, with a median score of 11.0. Although most physicians had average knowledge about the primary goals and general concepts of palliative care, misconceptions are highly prevalent. The commonly present misconceptions were that palliative care discourages patients from consulting other specialties (88.9%), refrains them from taking curative treatments (83.1%), and this care is only for older adults (74.5%), cancer patients (63%), and the last six months of life (56.4%). Age, educational qualifications, and specialties had significant relationships (P<0.05) with the level of knowledge. Conclusion Despite having average or above knowledge about palliative care, the physicians’ prevailing misconceptions act as a barrier to recognizing the need among the target populations. So, proper education and awareness among the physicians are necessary to cross this field’s barrier and development.
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Affiliation(s)
- Jheelam Biswas
- Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
- Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
- * E-mail:
| | - Palash Chandra Banik
- Department of Noncommunicable Diseases, Bangladesh University of Health Sciences (BUHS), Dhaka, Bangladesh
| | - Nezamuddin Ahmad
- Department of Palliative Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh
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Ananth P, Mun S, Reffat N, Li R, Sedghi T, Avery M, Snaman J, Gross CP, Ma X, Wolfe J. A Stakeholder-Driven Qualitative Study to Define High Quality End-of-Life Care for Children With Cancer. J Pain Symptom Manage 2021; 62:492-502. [PMID: 33556497 PMCID: PMC8339188 DOI: 10.1016/j.jpainsymman.2021.01.134] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 01/28/2021] [Accepted: 01/28/2021] [Indexed: 02/07/2023]
Abstract
CONTEXT Among adults with cancer, measures for high quality end-of-life care (EOLC) include avoidance of hospitalizations near end of life. For children with cancer, no measures exist to evaluate or improve EOLC, and adult quality measures may not apply. OBJECTIVE We engaged key stakeholders to explore EOLC priorities for children with cancer and their families, and to examine relevance of existing adult EOLC quality measures for children with cancer. METHODS In a multicenter qualitative study, we conducted interviews and focus groups with: adolescents and young adults (AYAs) with advanced cancer, parents of children with advanced cancer, bereaved parents, and interdisciplinary healthcare professionals. We transcribed, coded, and employed thematic analysis to summarize findings. RESULTS We enrolled 54 stakeholders (25 parents [including 12 bereaved parents], 10 AYAs, and 19 healthcare professionals). Participants uniformly prioritized direct communication with children about preferences and prognosis, interdisciplinary care, symptom management, and honoring family preference for location of death. Many participants valued access to the emergency department or hospital for symptom management or supportive care, which diverges from measures for high quality EOLC in adults. Most wished to avoid mechanical ventilation and cardiopulmonary resuscitation. Notably, participants generally valued hospice; however, few understood hospice care or had utilized its services. CONCLUSION Childhood cancer stakeholders define high quality EOLC primarily through person-centered measures, characterizing half of existing adult-focused measures as limited in relevance to children. Future research should focus on developing techniques for person-centered quality measurement to capture attributes of greatest importance to children with cancer and their families.
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Affiliation(s)
- Prasanna Ananth
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA; Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA.
| | - Sophia Mun
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA
| | - Noora Reffat
- Biological Sciences Division, University of Chicago Medicine¸ Chicago, Illinois, USA
| | - Randall Li
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Tannaz Sedghi
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA
| | - Madeline Avery
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Snaman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Cary P Gross
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA; Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Xiaomei Ma
- Yale Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, New Haven, Connecticut, USA; Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Joanne Wolfe
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Massachusetts, USA; Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Deeb S, Chino FL, Diamond LC, Tao A, Aragones A, Shahrokni A, Yerramilli D, Gillespie EF, Tsai CJ. Disparities in Care Management During Terminal Hospitalization Among Adults With Metastatic Cancer From 2010 to 2017. JAMA Netw Open 2021; 4:e2125328. [PMID: 34550384 PMCID: PMC8459194 DOI: 10.1001/jamanetworkopen.2021.25328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
IMPORTANCE Many patients with metastatic cancer receive high-cost, low-value care near the end of life. Identifying patients with a high likelihood of receiving low-value care is an important step to improve appropriate end-of-life care. OBJECTIVE To analyze patterns of care and interventions during terminal hospitalizations and examine whether care management is associated with sociodemographic status among adult patients with metastatic cancer at the end of life. DESIGN, SETTING, AND PARTICIPANTS This retrospective, population-based cross-sectional study used data from the Healthcare Cost and Utilization Project to analyze all-payer, encounter-level information from multiple inpatient centers in the US. All utilization and hospital charge records from national inpatient sample data sets between January 1, 2010, and December 31, 2017 (n = 58 761 097), were screened. The final cohort included 21 335 patients 18 years and older at inpatient admission who had a principal diagnosis of metastatic cancer and died during hospitalization. Data for the current study were analyzed from January 1, 2010, to December 31, 2017. EXPOSURES Patient demographic characteristics, patient insurance status, hospital location, and hospital teaching status. MAIN OUTCOMES AND MEASURES Receipt of systemic therapy (including chemotherapy and immunotherapy), receipt of invasive mechanical ventilation, emergency department (ED) admission, time from hospital admission to death, and total charges during a terminal hospitalization. RESULTS Among 21 335 patients with metastatic cancer who had terminal hospitalizations between 2010 and 2017, the median age was 65 years (interquartile range, 56-75 years); 54.0% of patients were female; 0.5% were American Indian, 3.3% were Asian or Pacific Islander, 14.1% were Black, 7.5% were Hispanic, 65.9% were White, and 3.1% were identified as other; 58.2% were insured by Medicare or Medicaid, and 33.2% were privately insured. Overall, 63.2% of patients were admitted from the ED, 4.6% received systemic therapy, and 19.2% received invasive mechanical ventilation during hospitalization. Racial and ethnic minority patients had a higher likelihood of being admitted from the ED (Asian or Pacific Islander patients: odds ratio [OR], 1.43 [95% CI, 1.20-1.72]; P < .001; Black patients: OR, 1.39 [95% CI, 1.27-1.52]; P < .001; and Hispanic patients: OR, 1.45 [95% CI, 1.28-1.64]; P < .001), receiving invasive mechanical ventilation (Black patients: OR, 1.59 [95% CI, 1.44-1.75]; P < .001), and incurring higher total charges (Asian or Pacific Islander patients: OR, 1.35 [95% CI, 1.13-1.60]; P = .001; Black patients: OR, 1.23 [95% CI, 1.13-1.34]; P < .001; and Hispanic patients: OR, 1.50 [95% CI, 1.34-1.69]; P < .001) compared with White patients. Privately insured patients had a lower likelihood of being admitted from the ED (OR, 0.47 [95% CI, 0.44-0.51]; P < .001), receiving invasive mechanical ventilation (OR, 0.75 [95% CI, 0.69-0.82]; P < .001), and incurring higher total charges (OR, 0.64 [95% CI, 0.59-0.68]; P < .001) compared with Medicare and Medicaid beneficiaries. CONCLUSIONS AND RELEVANCE In this study, patients with metastatic cancer from racial and ethnic minority groups and those with Medicare or Medicaid coverage were more likely to receive low-value, aggressive interventions at the end of life. Further studies are needed to evaluate the underlying factors associated with disparities at the end of life to implement prospective interventions.
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Affiliation(s)
- Stephanie Deeb
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Fumiko L. Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Lisa C. Diamond
- Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Anna Tao
- Tufts University School of Medicine, Boston, Massachusetts
| | - Abraham Aragones
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Armin Shahrokni
- Department of Geriatrics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Divya Yerramilli
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Erin F. Gillespie
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - C. Jillian Tsai
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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Abstract
OBJECTIVES The underrepresentation of Latinos in hospice care is well-documented. A gap remains, however, in the literature's description of the factors that shape Latino families' decisions to enroll in hospice care. The need for such understanding is dire considering the shifts in population and the research evidence that Latinos experience worse end-of-life outcomes compared to non-Latino whites. This study contributes to such understanding by exploring Latino older adults' experiences with healthcare broadly and reasons for choosing hospice care specifically, including how they learned about hospice and their understanding of the service at the time of enrollment. METHODS Semi-structured interviews were conducted with 13 hospice-enrolled Latinos 65 or older, or their decision-making proxies. Qualitative data was analyzed using thematic analysis. RESULTS Findings show that hospice represents a way to access services, and not necessarily a philosophy of care that Latinos understand or seek at end of life. CONCLUSION Healthcare providers such as hospital and hospice social workers must engage in efforts to enhance advance care planning discussions and hospice education with the Latino community.
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Affiliation(s)
- Susanny J Beltran
- University of Central Florida, School of Social Work, Orlando, FL, USA
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Myint AT, Tiraphat S, Jayasvasti I, Hong SA, Kasemsup V. Factors Influencing the Willingness of Palliative Care Utilization among the Older Population with Active Cancers: A Case Study in Mandalay, Myanmar. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157887. [PMID: 34360179 PMCID: PMC8345377 DOI: 10.3390/ijerph18157887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 01/08/2023]
Abstract
Palliative care is an effective, multidisciplinary healthcare service to alleviate severe illness patients from physical, psychological, and spiritual pain. However, global palliative care has been underutilized, especially in developing countries. This cross-sectional survey aimed to examine the factors associated with older cancer patients’ willingness to utilize palliative care services in Myanmar. The final sample was composed of 141 older adults, 50-years of age and above who suffered from cancers at any stage. Simple random sampling was applied to choose the participants by purposively selecting three oncology clinics with daycare chemotherapy centers in Mandalay. We collected data using structured questionnaires composed of five sections. The sections include the participant’s socio-economic information, disease status, knowledge of palliative care, psychosocial and spiritual need, practical need, and willingness to utilize palliative care services. The study found that approximately 85% of older cancer patients are willing to receive palliative care services. The significant predictors of willingness to utilize palliative care services include place of living, better palliative care knowledge, more need for spiritual and psychosocial support, and practical support. This study can guide health policymakers in increasing the rate of palliative care utilization. The suggested policies include developing community-level palliative care services in Myanmar, especially in rural areas, promoting palliative care knowledge, applying appropriate religious and spiritual traditions at palliative treatment, and developing suitable medicines for the critically ill.
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Affiliation(s)
- Aye Tinzar Myint
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand; (A.T.M.); (S.A.H.); (V.K.)
| | - Sariyamon Tiraphat
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand; (A.T.M.); (S.A.H.); (V.K.)
- Correspondence: ; Tel.: +66-2-441-9040-3 (ext. 54); Fax: +66-2-441-9044
| | - Isareethika Jayasvasti
- Institute of Nutrition, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand;
| | - Seo Ah Hong
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand; (A.T.M.); (S.A.H.); (V.K.)
| | - Vijj Kasemsup
- ASEAN Institute for Health Development, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom 73170, Thailand; (A.T.M.); (S.A.H.); (V.K.)
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
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On Board: Interdisciplinary Team Member Perspectives of How Patients With Heart Failure and Their Families Navigate Hospice Care. J Hosp Palliat Nurs 2021; 22:351-358. [PMID: 32658391 DOI: 10.1097/njh.0000000000000673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Hospice agencies serve an expanding population of patients with varying disease conditions and sociodemographic characteristics. Patients with heart failure represent a growing share of hospice deaths in the United States. However, limited research has explored the perspectives of hospice interdisciplinary team members regarding how patients with heart failure and their families navigate hospice care. We sought to address this research gap by conducting qualitative interviews with hospice interdisciplinary team members at a large, not-for-profit hospice agency in New York City (N = 32). Five overarching themes from these interviews were identified regarding components that members of the hospice interdisciplinary team perceived as helping patients with heart failure and their families navigate hospice care. These themes included (1) "looking out: caregiving support in hospice care," (2) "what it really means: patient knowledge and understanding of hospice," (3) "on board: acceptance of death and alignment with hospice goals," (4) "on the same page: communication with the hospice team," and (5) "like a good student: symptom management and risk reduction practices." Interdisciplinary team members delineated several components that influence how patients with heart failure and their families navigate hospice services and communicate with care providers. Hospice agencies should consider policies for augmenting services among patients with heart failure to improve their understanding of hospice, supplement available caregiving supports for patients without them, and remove communication barriers.
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Hakola OJ. Diversity in Representations and Voices of Terminally Ill People in End-of-Life Documentaries. J Palliat Care 2021; 37:190-196. [PMID: 33940985 PMCID: PMC9109586 DOI: 10.1177/08258597211013961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The 21st century has seen a proliferation of end-of-life
documentary films and television documentaries that contribute to building a
public image of hospice and palliative care. The way in which terminally ill
patients are represented in these documentaries creates impressions of who is
welcomed to receive end-of-life care. These documentary representations have not
been previously mapped. Methods: Using quantitative content
analysis, I analyzed 35 contemporary Western documentaries and studied their
diversity in the representations. I focused on terminally ill patients who are
given time and space in the narration to voice their views about the end-of-life
process. I paid attention to such elements as gender, race and ethnicity, age,
class, religion and sexuality. Results: The documentaries welcomed
the representations and voices of terminally ill people. Class, religion and
sexuality often had a marginal role in narration. The gender diversity of the
representations was quite balanced. Regarding age, the documentaries preferred
stories about working age patients for dramatic purposes, yet all age groups
were represented. However, the documentaries had an identifiable racial and
ethnic bias. With a few exceptions, terminally ill who had a personal voice in
the narrations were white. In comparison, racial and ethnic minorities were
either absent from most of the documentaries, or their role was limited to
illustrations of the general story. Conclusions: End-of-life
documentaries provide identifiable access to the patients’ experiences and as
such they provide emotionally and personally engaging knowledge about hospice
and palliative care. While these representations are people-oriented, they
include racial disparities and they focus mostly on the experiences of white
terminally ill patients. This bias reinforces the misleading image of hospice
and palliative care as a racialized healthcare service.
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Affiliation(s)
- Outi J Hakola
- Area and Cultural Studies, University of Helsinki, Helsinki, Finland
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Tate CE, Venechuk G, Pierce K, Khazanie P, Ingle MP, Morris MA, Allen LA, Matlock DD. Development of a Decision Aid for Patients and Families Considering Hospice. J Palliat Med 2021; 24:505-513. [PMID: 33439075 PMCID: PMC7987356 DOI: 10.1089/jpm.2020.0250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2020] [Indexed: 12/25/2022] Open
Abstract
Background: Hospice is underutilized. Miscommunication, decisional complexity, and misunderstanding around engaging hospice may contribute. Shared decision making (SDM), aided by patient decision aids (PtDAs), can improve knowledge and decision quality. Currently, there are no freely available hospice-specific PtDA to facilitate conversions between patients and providers about hospice care. Objective: To develop a theory-based and unbiased hospice specific PtDA. Design: Guided by the Ottawa Decision Support Framework and International Patient Decision Aid Standards, we used a theory-driven, eight-step, iterative, user-centered approach with multistakeholder input to develop a hospice-specific PtDA for anyone facing end-of-life decisions. Subjects: Feedback was obtained from a 10-member Patient Advisory Panel composed of lay patient advisors; focus groups of hospice providers, family caregivers, and patients; and the Palliative Care Research Group at University of Colorado Hospital consisting of palliative care physicians, midlevel providers, nurses, social workers, chaplains, and researchers. Results: There are many challenges in developing an unbiased hospice decision aid, including (1) balancing the provision of education (eligibility, payment) with decisional support, (2) clarifying values and incorporating emotion, (3) ideally representing the potential downsides of hospice, and (4) adequately capturing and describing care alternatives to hospice. Within this context, we developed a 12-page article and 17-minute video PtDAs. The PtDA openly acknowledges the emotional complexity of the decision and incorporates values clarification techniques to help decision makers reflect and evaluate their goals and preferences for end-of-life care. Conclusions: Hospice decision making is complex and emotional, demanding high-quality SDM aided by a formal PtDA. This work resulted in a freely available article and video PtDA for patients considering hospice. The effectiveness and implementation of these tools will be studied in future research. Clinical Trials Registration (NCT03794700 & NCT04458090).
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Affiliation(s)
- Channing E. Tate
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Gracie Venechuk
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Kenneth Pierce
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Prateeti Khazanie
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - M. Pilar Ingle
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Megan A. Morris
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Family Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Larry A. Allen
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Cardiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Daniel D. Matlock
- Adult and Child Consortium for Outcomes Research and Delivery Science (ACCORDS), School of Medicine, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
- Division of Geriatrics, University of Colorado School of Medicine, Aurora, Colorado, USA
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Aurora, Colorado, USA
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Halpert KD, Ward K, Sloane PD. Improving Advance Care Planning Documentation Using Reminders to Patients and Physicians: A Longitudinal Study in Primary Care. Am J Hosp Palliat Care 2021; 39:62-67. [PMID: 33754838 DOI: 10.1177/10499091211004890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Documenting advance care planning (ACP) in primary care requires multiple triggers. New Medicare codes make it easier for providers to bill for these encounters. This study examines the use of patient and provider reminders to trigger advance care planning discussions in a primary care practice. Secondary outcome was billing of new ACP billing codes. METHODS Patients 75 years and older scheduled for a primary care appointment were screened for recent ACP documentation in their chart. If none was found, an electronic or mail message was sent to the patient, and an electronic message to their provider, about the need to have discussion at the upcoming visit. Chart review was performed 3 months after the visit to determine if new ACP discussion was documented in the chart. RESULTS In the 3 months after the reminder had been sent to patients and providers, new ACP documentation or billing was found in 28.8% of the patients. Most new documentation was health care decision maker (75.6% of new documentation) with new DNR orders placed for 32.3% of these patients. The new Medicare billing code was filled 10 times (7.8%). CONCLUSION Reminders sent to both patients and providers can increase documentation of ACP during primary care visits, but rarely triggers a full ACP conversation.
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Affiliation(s)
- Karen D Halpert
- Department of Family Medicine, 2332University of North Carolina System, Chapel Hill, NC, USA
| | - Kimberly Ward
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Philip D Sloane
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Dressler G, Cicolello K, Anandarajah G. "Are They Saying It How I'm Saying It?" A Qualitative Study of Language Barriers and Disparities in Hospice Enrollment. J Pain Symptom Manage 2021; 61:504-512. [PMID: 32828932 DOI: 10.1016/j.jpainsymman.2020.08.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/31/2020] [Accepted: 08/10/2020] [Indexed: 11/21/2022]
Abstract
CONTEXT Language barriers contribute significantly to disparities in end-of-life (EOL) care. However, the mechanisms by which these barriers impact hospice care remains underexamined. OBJECTIVES To gain a nuanced understanding of how language barriers and interpretation contribute to disparities in hospice enrollment and hospice care for patients with limited English proficiency. METHODS Qualitative, individual interviews were conducted with a variety of stakeholders regarding barriers to quality EOL care in diverse patient populations. Interviews were audiorecorded and transcribed verbatim. Data were coded using NVivo 11 (QSR International Pty Ltd., Melbourne, Australia). Three researchers analyzed all data related to language barriers, first individually, then in group meetings, using a grounded theory approach, until they reached consensus regarding themes. Institutional review board approval was obtained. RESULTS Twenty-two participants included six nurses/certified nursing assistants, five physicians, three administrators, three social workers, three patient caregivers, and two chaplains, self-identifying from a variety of racial/ethnic backgrounds. Three themes emerged regarding language barriers: 1) structural barriers inhibit access to interpreters; 2) variability in accuracy of translation of EOL concepts exacerbates language barriers; and 3) interpreters' style and manner influence communication efficacy during complex conversations about prognosis, goals of care, and hospice. Our theoretical model derived from the data suggests that Theme 1 is foundational and common to other medical settings. However, Theme 2 and particularly Theme 3 appear especially critical for hospice enrollment and care. CONCLUSION Language barriers present unique challenges in hospice care because of the nuance and compassion required for delicate goals of care and EOL conversations. Reducing disparities requires addressing each level of this multilayered barrier.
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Affiliation(s)
- Gabrielle Dressler
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Katherine Cicolello
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Gowri Anandarajah
- Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA; Hope Hospice and Palliative Care Rhode Island, Providence, Rhode Island, USA.
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Abu-Odah H, Molassiotis A, Liu J. Lessons Learned from Countries That Have Introduced Palliative Care Services into Their National Health System: A Narrative Review. J Palliat Care 2021; 37:55-66. [PMID: 33525947 DOI: 10.1177/0825859721989557] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This review aims at gaining a broad overview of national approaches about Palliative care (PC) implementation into health care systems in countries that have PC identified within their national policies and strategies. METHODS Paper searching was conducted using both peer-reviewed databases and gray literature sources covering governmental reports with PC strategies from 2000 onward. Articles published in English that cited at least 1 category of the WHO's public health PC model were included. Qualitative content analysis was used for data analysis and synthesis of findings. RESULTS Thirteen reports met the inclusion criteria. Education and appropriate policies were the most frequent strategies covered by all countries included. Under education; information about training health care providers was needed for the effective introduction of a PC program. Reviewing standards of care required to deliver PC effectively, and financial support for PC service development were considered the central policies needed. Furthermore, partnerships and collaborations across the health systems as well as providing care based on patients' needs were required for the provision of a PC program. CONCLUSION It is of the essence to learn from countries demonstrating enhanced PC practices before the implementation of a new PC program in a given country. Such practices could be used as a guide and to address barriers that may hinder the development of PC at a national level. Best practices can be achieved by focusing on educational and policy-based strategies through identifying patients' needs, assessing general public awareness, health care providers' knowledge and training as well as incorporating stakeholders' perspectives.
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Affiliation(s)
- Hammoda Abu-Odah
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Alex Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Justina Liu
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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40
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Patel MN, Nicolla JM, Friedman FAP, Ritz MR, Kamal AH. Hospice Use Among Patients With Cancer: Trends, Barriers, and Future Directions. JCO Oncol Pract 2020; 16:803-809. [PMID: 33186083 DOI: 10.1200/op.20.00309] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Patients with advanced cancer and their families frequently encounter clinical and logistical challenges related to end-of-life care. Hospice provides interdisciplinary and holistic care to meet patients' biomedical, psychosocial, and spiritual needs in the last phases of life. Despite increasing general acceptance and use among patients with cancer, hospice remains underused. Underuse stems from ongoing misconceptions regarding hospice and its purpose, coupled with the rapid development of novel anticancer treatments, such as immunotherapies and targeted therapies, that have changed the landscape of possibilities. Furthermore, rapid evolutions in how end-of-life care is structured and reimbursed for will affect how oncology patients will intersect with hospice care. In this review, we explore the current and future challenges to greater integration of hospice care in the care of patients with advanced cancer and propose five recommendations as part of the path forward.
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Affiliation(s)
- Mihir N Patel
- Trinity College of Arts and Sciences, Duke University, Durham, NC
| | | | | | - Michala R Ritz
- Duke Cancer Institute, Duke University Medical Center, Durham, NC
| | - Arif H Kamal
- Duke Cancer Institute, Duke University Medical Center, Durham, NC.,Duke Fuqua School of Business, Durham, NC
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Shirsat N, Hoe D, Enguidanos S. Understanding Asian Indian Americans' Knowledge and Attitudes Toward Hospice Care. Am J Hosp Palliat Care 2020; 38:566-571. [PMID: 33107333 DOI: 10.1177/1049909120969128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Previous research has found racial differences in hospice knowledge and misconceptions about hospice care, which may hinder access to hospice care. Asian Indians are a rapidly growing population in the United States, yet limited research has focused on their beliefs toward end-of-life care. This project investigates Indian Americans' knowledge of and attitudes toward hospice care and advance care planning. PROCEDURES A cross-sectional design was employed using surveys about participants' knowledge of and attitudes toward hospice care and advance care planning. Surveys were conducted among Indian Americans, age 60 and over, recruited from Indian cultural centers in Northern California. The participants were first asked questions about hospice care. They were then given a summary explanation of hospice care and later asked about their attitudes toward hospice care. Data were analyzed using descriptive and bivariate analyses. RESULTS Surveys were completed by 82 participants. Findings revealed that 42.5% of respondents had an advance directive and 57.1% had named a health care proxy. Only 10% of respondents had known someone on hospice care and 10.4% correctly answered 4-5 of the knowledge questions. After being informed about hospice care, 69.6% of participants agreed that if a family member was extremely ill, they would consider enrolling him/her in hospice. CONCLUSIONS This study's results present a need for greater education about hospice services among older Asian Indians. Health practitioners should remain cognizant of potential misconceptions of hospice and cultural barriers that Asian Indians may have toward hospice care, so they can tailor conversations accordingly.
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Affiliation(s)
- Nikita Shirsat
- 5116University of Southern California, Los Angeles, CA, USA
| | - Deborah Hoe
- 5116University of Southern California, Los Angeles, CA, USA
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Cromwell CA, Edwards B, March AL. Improving Access to Palliative Care at a VHA Hospital. Am J Hosp Palliat Care 2020; 38:320-325. [PMID: 33030019 DOI: 10.1177/1049909120963079] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Explore veteran-specific factors impacting the acceptance of palliative care services at a Veterans Health Administration hospital. METHODS Prospective, focused one-on-one interviews were conducted with 18 inpatient veterans with an initial consult to receive palliative care services. Domains impacting reception of outpatient palliative care management were evaluated including knowledge deficit, emotional barriers, physical barriers, psychosocial barriers, and physical support. Themes and trends from interview responses were analyzed using a qualitative directed content analysis approach. RESULTS The following themes were discovered to influence veteran participation in outpatient palliative care: Knowledge Deficit, Environmental Factors, Positive Patient Satisfaction, Openness to Technology, and Resiliency. Characteristics of veterans interviewed included an average age of 71 with an average distance from the hospital of 59 miles. CONCLUSION The identification of factors impacting veteran access to palliative care will be used to guide interventions and improve receipt of services. Care of seriously ill veterans may be substantially improved by facilitating access to palliative care.
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Affiliation(s)
| | | | - Alice L March
- 20120Central Texas Veterans Health Care System, Temple, TX, USA
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Xie Y, Xu Y, Yang S, Yan J, Jin XQ, Liu C. Investigation of the awareness of and demand for hospice care and attitudes towards life-sustaining treatment at the end of life among community residents in Hangzhou. BMC Palliat Care 2020; 19:128. [PMID: 32807160 PMCID: PMC7433355 DOI: 10.1186/s12904-020-00628-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To understand the status of residents' awareness of and demand for hospice care services in Hangzhou and to provide a reference for promoting the formulation of hospice care-related policies in China. METHODS A small cross-sectional survey of 519 adults aged over 40 years old living in the rural-urban fringe and urban area of Xihu District, Hangzhou City, was conducted using convenience sampling and a self-designed questionnaire. The measures assessed awareness of hospice care (13-item scale), attitudes towards life support therapy (3-item scale), and demand for hospice care services (9-item scale). RESULTS The rate of awareness of hospice care among community residents was 50.30%. A total of 51.0% of residents wanted only comfortable life-sustaining treatment at the end of their lives. The acceptance of hospice care was positively correlated with the degree of understanding (x2 = 18.382, P = 0.001), and residents in the urban area were more likely to prefer hospice care than residents in the urban-rural fringe (x2 = 7.186, P = 0.028). Elderly residents showed a stronger tendency to prefer comfortable life support therapy (x2 = 12.988, P < 0.001). A total of 83.04% of the residents accepted the current necessity for hospice care to be provided in medical institutions. The preferred locations were professional hospice care institutions or general hospitals. A total of 93.64% of the residents agreed that the number of beds in hospice care wards should not exceed 2. In addition, the residents could afford part of the out-of-pocket expenses for hospice care services, with the ability to pay under 200 yuan per day, and the improvement of facilities was expected. CONCLUSIONS To improve public awareness and acceptance of hospice care and promote healthy development in China, it is necessary to promote hospice care education for everyone.
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Affiliation(s)
- Yanhong Xie
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Ying Xu
- Department of Nursing, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China.
| | - Shulan Yang
- Department of Nursing, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Jing Yan
- Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Xiao Qing Jin
- Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
| | - Caixia Liu
- Department of Nursing, Zhejiang Hospital, Hangzhou, 310013, Zhejiang Province, China
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El-Jawahri A, Traeger L, Greer JA, Vanbenschoten O, Markovitz N, Cashavelly B, Tata LA, Nipp RD, Reynolds KL, Goyal L, Bhatt S, Fishman S, Horick N, Li Z, Volandes A, Temel JS. Randomized trial of a hospice video educational tool for patients with advanced cancer and their caregivers. Cancer 2020; 126:3569-3578. [PMID: 32508043 DOI: 10.1002/cncr.32967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/28/2020] [Accepted: 04/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Patients with advanced cancer and their caregivers have substantial misperceptions regarding hospice, which contributes to its underuse. METHODS The authors conducted a single-site randomized trial of a video educational tool versus a verbal description of hospice in 150 hospitalized patients with advanced cancer and their caregivers. Patients without a caregiver were eligible. Intervention participants (75 patients and 18 caregivers) viewed a 6-minute video depicting hospice. Control participants (75 patients and 26 caregivers) received a verbal description identical to the video narrative. The primary outcome was patient preference for hospice. Secondary outcomes included patient and/or caregiver knowledge and perceptions of hospice, and hospice use. RESULTS Between February 2017 and January 2019, approximately 55.7% of eligible patients (150 of 269 eligible patients) and 44 caregivers were enrolled. After the intervention, there was no difference noted with regard to patients' preferences for hospice (86.7% vs 82.7%; P = .651). Patients in the video group reported greater knowledge regarding hospice (9.0 vs 8.4; P = .049) and were less likely to endorse that hospice is only about death (6.7% vs 21.6%; P = .010). Among deceased patients, those assigned to the intervention were more likely to have used hospice (85.2% vs 63.6%; P = .01) and to have had a longer hospice length of stay (median, 12 days vs 3 days; P < .001). After the intervention, caregivers assigned to view the video were more likely to prefer hospice for their loved ones (94.4% vs 65.4%; P = .031), reported greater knowledge concerning hospice (9.7% vs 8.0%; P = .001), and were less likely to endorse that hospice is only about death (0.0% vs 23.1%; P = .066). CONCLUSIONS A hospice video did not significantly impact patients' preferences for hospice care. Patients with advanced cancer and their caregivers who were assigned to view the video were more informed regarding hospice and reported more favorable perceptions of hospice. Patients were more likely to use hospice and to have a longer hospice length of stay.
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Affiliation(s)
- Areej El-Jawahri
- Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Lara Traeger
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph A Greer
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Olivia Vanbenschoten
- Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Netana Markovitz
- Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Barbara Cashavelly
- Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lee Ann Tata
- Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Ryan D Nipp
- Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Kerry L Reynolds
- Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Lipika Goyal
- Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Sunil Bhatt
- Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sarah Fishman
- Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Nora Horick
- Department of Biostatistics, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Zhigang Li
- University of Florida at Gainesville, Gainesville, Florida, USA
| | - Angelo Volandes
- Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer S Temel
- Department of Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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Grant MS, Back AL, Dettmar NS. Public Perceptions of Advance Care Planning, Palliative Care, and Hospice: A Scoping Review. J Palliat Med 2020; 24:46-52. [PMID: 32614634 DOI: 10.1089/jpm.2020.0111] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Although access to advance care planning (ACP), palliative care, and hospice has increased, public attitudes may still be barriers to their optimal use. Purpose: To synthesize empirical research from disparate sources that describes public perceptions of ACP, palliative care, and hospice in ways that could inform public messaging. Data Sources: Searches of PubMed and other databases were made from January 2011 to January 2020. Study Selection: Studies reporting survey or interview data with the public that asked specifically about awareness and attitudes toward ACP, palliative care, or hospice were included. Data Extraction and Synthesis: Two reviewers independently screened citations, read full texts, and performed data abstraction. Twelve studies met inclusion criteria and included >9800 participants. For ACP, 80% to 90% of participants reported awareness, and a similar proportion considered it important, but only 10% to 41% reported having named a proxy or completed a written document. For palliative care, 66% to 71% of participants reported no awareness of palliative care, and those who reported awareness often conflated it with end-of-life care. However, after being prompted with a tested definition, 95% rated palliative care favorably. For hospice, 86% of participants reported awareness and 70% to 91% rated it favorably, although 37% held significant misconceptions. Limitations: A limited number of studies met inclusion criteria, and some were published in nonpeer reviewed sources. The studies reflect public perceptions pre-COVID-19. Conclusion: Consumer perceptions of ACP, palliative care, and hospice each have a distinct profile of awareness, perceptions of importance, and reports of action taking, and these profiles represent three different challenges for public messaging.
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Affiliation(s)
- Marian S Grant
- School of Nursing, University of Maryland, Baltimore, Maryland, USA
| | - Anthony L Back
- School of Medicine, University of Washington, Seattle, Washington, USA
| | - Nicole S Dettmar
- Northwest Center for Public Health Practice, University of Washington, Seattle, Washington, USA
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Ko E, Fuentes D, Singh-Carlson S, Nedjat-Haiem F. Challenges and facilitators of hospice decision-making: a retrospective review of family caregivers of home hospice patients in a rural US-Mexico border region-a qualitative study. BMJ Open 2020; 10:e035634. [PMID: 32611740 PMCID: PMC7332198 DOI: 10.1136/bmjopen-2019-035634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Hospice care (HC) is seen as a comprehensive approach, that enhances quality of end-of-life (EOL) care, for terminally ill patients. Despite its positive aspects, HC enrolment is disproportionate for rural patients, who are less likely to use HC in comparison to their urban counterparts. The purpose of this study was to explore decision-making experiences, related to utilisation of HC programmes from a retrospective perspective, with family caregivers (FCGs) in a rural US-Mexico border region. DESIGN This qualitative study was conducted from May 2017 to January 2018 using semistructured face to face interviews with FCGs. Data were analysed using thematic analysis. SETTING The HC programme was situated at a local home health agency, located in rural Southern California, USA. PARTICIPANTS Twenty-eight informal FCGs of patients who were actively enrolled in the HC programme agreed to participate in the study. RESULTS Conversation about HC as an option was initiated by home healthcare staff (39.3%), followed by physicians (32.1%). Emerging themes related to challenges in utilisation of HC and decision-making included: (1) communication barriers; (2) lack of knowledge/misperception about HC; (3) emotional difficulties, including fear of losing their patient, doubt and uncertainty about the decision, denial and (4) patients are not ready for HC. Facilitators included: (1) patient's known EOL wishes; (2) FCG-physician EOL communication; (3) the patient's deteriorating health and (4) home as the place for death. CONCLUSIONS HC patients' FCGs in this rural region reported a lack of knowledge or misunderstanding of HC. It is recommended that healthcare providers need to actively engage family members in patient's EOL care planning. Optimal transition to an HC programme can be facilitated when FCGs are informed and have a clear understanding about patients' medical status along with information about HC.
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Affiliation(s)
- Eunjeong Ko
- Social Work, San Diego State University, San Diego, California, USA
| | - Dahlia Fuentes
- Social Work, San Diego State University, San Diego, California, USA
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Dixe MDA, Santo IDDO, Lopes S, Catarino H, Duarte S, Querido A, Laranjeira C. Knowledge and Myths about Palliative Care among the General Public and Health Care Professionals in Portugal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134630. [PMID: 32605086 PMCID: PMC7369792 DOI: 10.3390/ijerph17134630] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/16/2022]
Abstract
Background: International research has shown that healthcare professionals (HCPs) and nonhealthcare professionals (NHCPs) are unaware of the goals and purposes of palliative care. This study evaluates the knowledge of palliative care among a sample of Portuguese adults and correlates their level of knowledge with age, gender, profession, and experience of family member’s palliative care. Method: A cross-sectional online survey was carried out on a sample of 152 HCPs and 440 NHCPs who completed an anonymous questionnaire of sociodemographic, family, and professional data, and an instrument of 26 dichotomous (true or false) questions focusing on palliative care goals and purposes. Results: The 592 participants had a mean age of 31.3 ± 11.1 years, and most were female. Statistically significant differences between statements considered as correct by HCPs and NHCPs were found in 24 statements; HCPs had the highest percentage of correct answers. The terms most frequently associated with palliative care mentioned by NHCPs were chronic and progressive disease (n = 76), while HCPs mostly mentioned quality-of-life promotion (n = 29). Women, the elderly, and HCPs had a higher level of knowledge regarding palliative care (p < 0.001). Conclusions: Results clearly show gaps in knowledge of palliative care, especially among NHCPs. An integrated approach is needed to inform and clarify the philosophy and goals of palliative care in different settings in order to improve knowledge.
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Affiliation(s)
- Maria dos Anjos Dixe
- School of Health Sciences of Polytechnic Institute of Leiria (IPLeiria), Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria Leiria, Portugal; (S.L.); (H.C.); (A.Q.); (C.L.)
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Politécnico de Leiria, 2410-541 Leiria, Portugal;
- Correspondence:
| | - Irene Dixe de Oliveira Santo
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Politécnico de Leiria, 2410-541 Leiria, Portugal;
- Weiss Memorial Hospital, 4646 North Marine Drive, Chicago, IL 60640, USA
| | - Saudade Lopes
- School of Health Sciences of Polytechnic Institute of Leiria (IPLeiria), Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria Leiria, Portugal; (S.L.); (H.C.); (A.Q.); (C.L.)
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Politécnico de Leiria, 2410-541 Leiria, Portugal;
| | - Helena Catarino
- School of Health Sciences of Polytechnic Institute of Leiria (IPLeiria), Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria Leiria, Portugal; (S.L.); (H.C.); (A.Q.); (C.L.)
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Politécnico de Leiria, 2410-541 Leiria, Portugal;
| | - Susana Duarte
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra (ESEnfC), 3046-851 Coimbra, Portugal;
| | - Ana Querido
- School of Health Sciences of Polytechnic Institute of Leiria (IPLeiria), Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria Leiria, Portugal; (S.L.); (H.C.); (A.Q.); (C.L.)
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Politécnico de Leiria, 2410-541 Leiria, Portugal;
- Center for Research in Health and Information Systems (CINTESIS), NursID, University of Porto, 4200-450 Porto, Portugal
| | - Carlos Laranjeira
- School of Health Sciences of Polytechnic Institute of Leiria (IPLeiria), Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria Leiria, Portugal; (S.L.); (H.C.); (A.Q.); (C.L.)
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André—66–68, Campus 5, Politécnico de Leiria, 2410-541 Leiria, Portugal;
- Research in Education and Community Intervention (RECI I&D), Piaget Institute of Viseu, 3515-776 Viseu, Portugal
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The COMFORT Communication Model: A Nursing Resource to Advance Health Literacy in Organizations. J Hosp Palliat Nurs 2020; 22:229-237. [PMID: 32282558 DOI: 10.1097/njh.0000000000000647] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The COMFORT Model has recently been revised based on feedback from bedside nurses working in palliative care and oncology and includes the following components: Connect, Options, Making Meaning, Family Caregiver, Openings, Relating, and Team. Based on clinical and nonclinical research in hospital, hospice, palliative care, and interdisciplinary education settings, the authors present the updated COMFORT Model. Originally introduced in 2012 to support the work of the nurse, the model is not a linear guide, an algorithm, a protocol, or a rubric for sequential implementation by nurses, but rather a set of communication principles that are practiced concurrently and reflectively during patient/family care. In its restructuring, we focus on the role of health literacy throughout the COMFORT components in relationship to the health literacy attributes of a health care organization. A brief summary of COMFORT components is provided and includes strategies and competencies contributing to a health-literate care organization. Both health literacy and COMFORT are explored using specific communication challenges that underscore the role of the nurse in accomplishing person-centered and culturally responsive care, especially in chronic and terminal illness. The integration of the COMFORT Model into nursing education is proposed.
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Brereton EJ, Matlock DD, Fitzgerald M, Venechuk G, Knoepke C, Allen LA, Tate CE. Content Analysis of Negative Online Reviews of Hospice Agencies in the United States. JAMA Netw Open 2020; 3:e1921130. [PMID: 32049299 PMCID: PMC8409083 DOI: 10.1001/jamanetworkopen.2019.21130] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE As online reviews of health care become increasingly integral to patient decision-making, understanding their content can help health care practices identify and address patient concerns. OBJECTIVE To identify the most frequently cited complaints in negative (ie, 1-star) online reviews of hospice agencies across the United States. DESIGN, SETTING, AND PARTICIPANTS This qualitative study conducted a thematic analysis of online reviews of US hospice agencies posted between August 2011 and July 2019. The sample was selected from a Hospice Analytics database. For each state, 1 for-profit (n = 50) and 1 nonprofit (n = 50) hospice agency were randomly selected from the category of extra-large hospice agencies (ie, serving >200 patients/d) in the database. Data analysis was conducted from January 2019 to April 2019. MAIN OUTCOMES AND MEASURES Reviews were analyzed to identify the most prevalent concerns expressed by reviewers. RESULTS Of 100 hospice agencies in the study sample, 67 (67.0%) had 1-star reviews; 33 (49.3%) were for-profit facilities and 34 (50.7%) were nonprofit facilities. Of 137 unique reviews, 68 (49.6%) were for for-profit facilities and 69 (50.4%) were for nonprofit facilities. A total of 5 themes emerged during the coding and analytic process, as follows: discordant expectations, suboptimal communication, quality of care, misperceptions about the role of hospice, and the meaning of a good death. The first 3 themes were categorized as actionable criticisms, which are variables hospice organizations could change. The remaining 2 themes were categorized as unactionable criticisms, which are factors that would require larger systematic changes to address. For both for-profit and nonprofit hospice agencies, quality of care was the most frequently commented-on theme (117 of 212 comments [55.2%]). For-profit hospice agencies received more communication-related comments overall (34 of 130 [26.2%] vs 9 of 82 [11.0%]), while nonprofit hospice agencies received more comments about the role of hospice (23 of 33 [69.7%] vs 19 of 31 [61.3%]) and the quality of death (16 [48.5%] vs 12 [38.7%]). CONCLUSIONS AND RELEVANCE Regarding actionable criticisms, hospice agencies could examine their current practices, given that reviewers described these issues as negatively affecting the already difficult experience of losing a loved one. The findings indicated that patients and their families, friends, and caregivers require in-depth instruction and guidance on what they can expect from hospice staff, hospice services, and the dying process. Several criticisms identified in this study may be mitigated through operationalized, explicit conversations about these topics during hospice enrollment.
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Affiliation(s)
- Elinor J Brereton
- Adult and Child Consortium for Outcomes Research and Delivery Science, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora
| | - Daniel D Matlock
- Adult and Child Consortium for Outcomes Research and Delivery Science, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora
- Division of Geriatrics, University of Colorado School of Medicine, Aurora
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver
| | - Monica Fitzgerald
- Adult and Child Consortium for Outcomes Research and Delivery Science, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora
| | - Grace Venechuk
- Adult and Child Consortium for Outcomes Research and Delivery Science, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora
| | - Chris Knoepke
- Adult and Child Consortium for Outcomes Research and Delivery Science, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora
- Division of Cardiology, University of Colorado School of Medicine, Aurora
| | - Larry A Allen
- Adult and Child Consortium for Outcomes Research and Delivery Science, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora
- Division of Cardiology, University of Colorado School of Medicine, Aurora
| | - Channing E Tate
- Adult and Child Consortium for Outcomes Research and Delivery Science, Anschutz Medical Campus, University of Colorado School of Medicine, Aurora
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Perry LM, Hoerger M, Malhotra S, Gerhart JI, Mohile S, Duberstein PR. Development and Validation of the Palliative Care Attitudes Scale (PCAS-9): A Measure of Patient Attitudes Toward Palliative Care. J Pain Symptom Manage 2020; 59:293-301.e8. [PMID: 31539604 DOI: 10.1016/j.jpainsymman.2019.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/05/2019] [Accepted: 09/06/2019] [Indexed: 11/28/2022]
Abstract
CONTEXT Palliative Care is underutilized, and research has neglected patient-level factors including attitudes that could contribute to avoidance or acceptance of Palliative Care referrals. This may be due in part to a lack of existing measures for this purpose. OBJECTIVES The objective of this study was to develop and validate a nine-item scale measuring patient attitudes toward Palliative Care, comprised of three subscales spanning emotional, cognitive, and behavioral factors. METHODS Data were collected online in three separate waves, targeting individuals with cancer (Sample 1: N = 633; Sample 2: N = 462) or noncancer serious illnesses (Sample 3: N = 225). Participants were recruited using ResearchMatch.org and postings on the web sites, social media pages, and listservs of international health organizations. RESULTS Internal consistency was acceptable for the total scale (α = 0.84) and subscales: emotional (α = 0.84), cognitive (αs = 0.70), and behavioral (α = 0.90). The PCAS-9 was significantly associated with a separate measure of Palliative Care attitudes (ps < 0.001) and a measure of Palliative Care knowledge (ps < 0.004), supporting its construct validity in samples of cancer and noncancer serious illnesses. The scale's psychometric properties, including internal consistency and factor structure, generalized across patient subgroups based on diagnosis, other health characteristics, and demographics. CONCLUSION Findings support the overall reliability, validity, and generalizability of the PCAS-9 in serious illness samples and have implications for increasing Palliative Care utilization via clinical care and future research efforts.
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Affiliation(s)
- Laura M Perry
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA.
| | - Michael Hoerger
- Department of Psychology, Tulane University, New Orleans, Louisiana, USA; Department of Medicine, Section of Hematology and Medical Oncology, Tulane University, New Orleans, Louisiana, USA
| | - Sonia Malhotra
- Department of General Internal Medicine & Geriatrics, Section of Palliative Medicine, Tulane University, New Orleans, Louisiana, USA
| | - James I Gerhart
- Department of Psychology, Central Michigan University, Mount Pleasant, Michigan, USA
| | - Supriya Mohile
- James P. Wilmot Cancer Center, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Paul R Duberstein
- Department of Health Behavior, Society and Policy, Rutgers University School of Public Health, Piscataway, New Jersey, USA
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